As emergency medicine physicians, we are trained to handle any kind of medical situation. But what happens when you take away all of our equipment and put us in a low-oxygen metal container at 30,000 feet? Here’s what you need to know in case you hear the overhead call for a medical physician on your next commercial flight.

General Information

- The most common emergencies are chest pain, syncope, asthma exacerbations and GI complaints.

- As health professionals are not required or present on every flight, most airlines have a contract with a medical consultation service.

- The service, typically staffed by emergency physicians, fields calls by the flight attendants and directs them on medications and whether an emergency landing is indicated.

Advice on how to approach the situation if you hear the overhead call

- Introduce yourself to the cabin crew and state your qualifications (I recommend keeping a photo of your medical ID on your phone)

- Ask patient for their permission before performing care, if possible.

- Perform an assessment with a history and physical.

- Cooperate with the medical consultation center and coordinate with airport medical staff.

- If patients condition is critical, recommend a diversion to the nearest airport

- Keep a written medical record of your patient encounter.

What medical equipment and support can you expect to find

- The flight crew will be trained in CPR

- The FAA requires all US commercial airlines to have a AED*, basic first aid kids (i.e. bandages and gauze) and an enhanced emergency medical kit

- Other required equipment includes a blood pressure cuff, stethoscope and gloves

 *The AED likely will not have rhythm strip capabilities

The enhanced kit will contain the following required equipment

- Oropharyngeal airways (3 sizes), Bag-valve masks (3 sizes) and CPR masks

- IV needles, syringes and saline solution (500cc NS)

- Medications: Antihistamine 25mg tabs and 50mg injectable, Aspirin 325mg, Atropine 0.5mg, bronchodilator inhaler, Dextrose 50%, Epinephrine (both 1:1,000 and 1:10,000 solutions), lidocaine 5cc 20mg/ml injectible and nitroglycerin 0.4mg tablets

- Some airlines may have additional medications. Check with the staff

To ease your mind regarding Medical-Legal Liability

- The Aviation Medical Assistance Act of 1998 provides some protection for physicians and other medical professionals who volunteer their services during flight

- It is implied that you will act in good faith and are not guilty of “gross negligence or willful misconduct.” Obviously you must be sober in order to provide care!

- ACEP recommends to receive no monetary compensation to be protected under this Act.

- Lastly, there are no documented cases of a physician being sued for providing assistance during an in-flight emergency

Resources

Chandra, A Conry, S. “Be Prepared for In-Flight Medical Emergencies.” ACEP News. August 2010. https://www.acep.org/Clinical-- -Practice- Management/Be-Prepared- for-In- Flight-Medical-Emergencies/

Federal Aviation Administration (FAA), Department of Transportation. Emergency medical equipment: final rule. Fed Regist 2001;66:19028-19046. https://www.gpo.gov/fdsys/pkg/FR-2001-04- 12/pdf/01-8932.pdf

Nable, JV. et al. In-Flight Medical Emergencies during Commercial Flight. N Engl J Med 2015; 373:939-945. http://www.nejm.org/doi/full/10.1056/NEJMra1409213